Medicare guidance is here
I’ve had trouble finding a doctor who accepts Medicare. Is there a source that can help?
You’re not alone when it comes to having difficulty finding a doctor who will accept Medicare, the government health insurance program for seniors. People have long complained that doctors have either dropped out of the program or are no longer accepting new Medicare patients into their practice.
The challenge varies greatly by region and by the type of doctor you’re looking for — specialists such as psychiatrists seem to be in short supply in many areas, for example. Many people around the country also report problems finding a primary care doctor. Generally speaking, those living in rural areas have a tougher time finding doctors who’ll accept Medicare, while people enrolled in Medicare Advantage plans, which are administered by private insurance companies, have fewer complaints than those with original Medicare.
In 2010, 75% of Medicare beneficiaries said they didn’t have a problem getting a doctor’s appointment for routine care, according to this year’s annual report by the Medicare Payment Advisory Commission, an independent congressional agency. The numbers were even better for people who needed immediate access to a doctor because of an illness or injury.
Still, the report acknowledges that “a small share of the Medicare population continues to report problems finding a new primary care physician.”
“I think it’s becoming more difficult to find providers who will accept Medicare,” says David Lipschutz, an attorney with the Center for Medicare Advocacy, a nonprofit education and advocacy organization in Willimantic, Conn. Lipschutz says the reasons for this are varied, but one often cited is a looming cut in physician reimbursement that Congress has voted to postpone each year.
If you’re having a hard time finding a doctor who accepts Medicare, there are resources available to help you. For starters, check out the Physician Compare tool on Medicare.gov by going to the “Facilities and Doctors” tab on the home page and clicking on “Find a Doctor.” There you can search for providers by specialty type and ZIP Code.
Just be sure to call the doctor’s office to confirm that he or she is accepting Medicare patients regardless of what you see on the website. According to Elaine Wong Eakin, executive director of the nonprofit California Health Advocates in Sacramento, the lists could use more frequent updates. “We’ve found doctors on the list who are retired,” she says.
If you don’t have Internet access or just prefer to talk to a human, you can also call (800) MEDICARE to get the same information from a representative.
California’s Health Insurance Counseling and Advocacy Program (HICAP) is a great resource for those living in the state. To find the HICAP office in your area, go to the California Department of Aging website at https://www.aging.ca.gov/hicap/countyList.aspx. Phone numbers and addresses are available by county.
State Health Insurance Counseling and Assistance Programs (SHIP) offer free personalized Medicare counseling throughout the country. To find the SHIP near you, visit the Medicare Helpful Contacts page at https://www.medicare.gov/contacts or call (800) MEDICARE.
How do I get inaccurate information removed from my medical record?
You can’t remove information from your medical record, but you have the right to request an amendment to any information within your record that you think is incorrect or incomplete.
To start the process, ask your healthcare provider or hospital if there is a particular process or form for requesting a medical record amendment. Providers have the right to require that you put your request in writing. Under the federal Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, they have to respond within 60 days of your request and let you know if they either accept it and will make the change or if they have chosen to reject it.
If the errors are clear and factual in nature — for instance, if information was inaccurately transcribed or scanned into the wrong record — the doctor shouldn’t object to amending your record, says Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology, a nonprofit organization in Washington, D.C. “They have an interest for a whole lot of reasons in keeping accurate records,” she says.
There are a number of possible reasons, however, why a provider would deny a request to add an amendment, not least of which is a dispute over a diagnosis or a physician’s interpretation of a patient’s condition.
“If the information in the record in any way affects the person’s treatment, they’re not going to want to remove it,” says Nina Kudszus, co-author of many of the Getting Your Medical Records guides produced by the Center on Medical Record Rights and Privacy at Georgetown University’s Health Policy Institute. “It’s really about making sure that the record is comprehensive and accurately reflects what has gone on,” says Kudszus, now a health analyst with the consulting firm Booz Allen Hamilton in Washington, D.C.
If your doctor denies your request, you still have the right to have your version of the facts included with your record, McGraw says.
You can ask to have a statement of your views added to your record so that anyone who subsequently sees it will also see that you’ve disputed the information. In California, the statement for each disputed item must be limited to 250 words. You can see the regulations for all states at Georgetown University’s site, medicalrecordrights.georgetown.edu/records.html.
Your amendment, Kudszus says, should make it clear that the information is to be made part of the record, and the law requires your doctor to comply with this request. In addition, your doctor has the right to include a rebuttal to your claim, which would also travel with your record from that point forward.
If you need the amended information sent to another healthcare provider, give the contact information to your doctor. He or she is then required to send it to the individuals or organizations you identified.
Having trouble making headway? You can file a complaint with your state medical board. In California, go to https://www.medbd.ca.gov, then navigate your way to the consumer portion of the site. You can find links to all state medical boards by going to the American Medical Assn.'s website, https://www.ama-assn.org. Click on the “Patients” tab, then select “Medical Society Directories.”
You can also initiate a complaint with the Department of Health and Human Services’ Office for Civil Rights, which is the body that enforces the HIPAA Privacy Rule. Information can be found online at https://www.hhs.gov/ocr.
Zamosky has been writing about how to access and pay for healthcare for more than 10 years.
Got a healthcare dilemma? Email firstname.lastname@example.org or write to Health 411, Los Angeles Times Health, 202 W. 1st St., Los Angeles, CA 90012.